Amir is a 36 year old active small business owner who spends every Tuesday evening at the gym playing basketball with his friends. Six months ago, on one of those typical Tuesday nights it happened. Amir was driving in for a lay up and suddenly it felt like someone kicked him in the back of his leg. He stumbled and went down on the court. He quickly got up to see who had kicked him and soon realized no one was there. He stumbled to the sidelines with improving pain but a strong feeling something was not right.
The Breakdown
Amir was not wrong in his evaluation. He had just suffered the rupturing of his Achilles tendon. I have heard stories like this many times over the years. Achilles ruptures occur in approximately 1 in 10,000 people per year, with the majority being active 30-50 year old males. In my experience, well over half the Achilles ruptures that I have treated have been 30-40 year old males playing basketball.
Ruptures occur most commonly when pushing off with your foot with significant force such as jumping, or when the foot is forced up to the point that the tendon cannot stretch any further. I have had patients with other causes such as getting hit in the back of the heel with a grocery cart, falling and hitting the tendon on a concrete barrier, or even having a knife fall off the counter and stab straight down into the tendon.
One important thing, no matter how it happens, is quickly recognizing the problem and staying off the affected leg. By recognizing the problem and not putting weight on that leg you can potentially prevent further separation of the ends and increase your chance for good treatment results. Recognizing the injury immediately and getting early treatment also helps to prevent the need for much larger surgeries, such as the those needed for chronic ruptures.
Amir’s Story
Amir was not convinced of his rupture since he could still walk on that foot and the pain was only minor. He decided to give it a day or 2 and see how things went. Over a couple of days his pain and swelling had greatly improved, however he noticed a distinct weakness in the leg. Amir then decided to call the office and explained what had occurred. After hearing his concerns, he was told to come in and get it checked out.
At the visit it was quickly determined that he had a full thickness Achilles tendon rupture with a distinct gap that could be felt in the tendon. An MRI was ordered to see how significant the tendon gap was and to determine if any chronic tendon changes were present. He was then seen in the office to review his MRI images and discuss treatment options.
Decision Time
Treatment options for Achilles tendon ruptures include both non-surgical and surgical options. Recent studies have shown that the non-surgical option can be an effective treatment, but I would argue that most specialists still hold to surgery giving the most predictable outcomes. Especially if there is a gap between the tendon ends.
The primary surgical goal is to bring the tendon ends together and keep them together during the healing process. Sutures are woven through the tendon and either tied together or anchored into the heel bone. Repairs that are performed within a couple of weeks of a rupture are most commonly performed via a minimal incision type approach, while delayed treatments often times require more extensive exposures.
Recovery protocol is likely the most important part of the whole Achilles treatment process. The timing of range of motion exercises, along with progression through the immobilization process is a significant factor in achieving great results. Getting patients moving quickly in an appropriate safe way improves tendon healing and reduces downtime.
Over the past 20 years of repairing Achilles tendon ruptures, I have been modernizing the methods that I use in repairing these tendons along with updating recovery protocols that follow the surgery. The goal is to give my patients the quickest recovery with the best results no matter if they are a professional athlete or a grandparent.
Amir’s Conclusion
Amir decided to have his tendon repaired. I performed his repair using a minimal approach technique that involves passing a guide up along the tendon that allows for sutures to be passed through the skin in what is termed a percutaneous repair technique. Two weeks after his surgery he was allowed to balance and walk with partial weight on his foot with a boot and crutches, as well as, beginning passive range of motion exercises. At 4 weeks he was walking in his boot and starting to work with the physical therapist. At 8 weeks after surgery he began to walk in a shoe. Then 4 months after his injury, and numerous sessions of hard work at home and with his physical therapist, he was rewarded with his release to return to the basketball court.